Study finds links between infection and retail poultry
by Randy Dotinga, Contributing Writer, MedPage Today October 09, 2017

Action Points
• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Note that this observational study found that of 49 genotypes of E. coli isolated from human urinary tract infections, 12 were found in retail meat.
• While this could merely reflect the fact that common E. coli variants are common, it adds to a concern that meat-borne E. coli may lead to human UTI.

SAN DIEGO — For years, researchers have been trying to confirm an apparent link between the Escherichia coli in poultry and urinary tract infections (UTIs) in humans. Now, there’s another hint of a connection between contamination back on the farm and nasty germs in our bladders.
Researchers who examined meat from retail stores in California and urine from patients with UTIs found that nearly 25% of chicken and turkey samples shared the same genotypes that were found in the urine samples, according to Reina Yamaji, MD, PhD, of the University of California at Berkeley.
Analysis showed 72 E coli genotypes that were unique to retail meat, 49 genotypes unique to human UTIs, and 12 shared genotypes, Yamaji reported at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).
Of the six most common E coli genotypes in humans, three of them were found in both retail meat and humans, she said.
The findings don’t solve the mystery of whether the meats we eat — especially poultry — are directly related to human UTIs, an outside expert told MedPage Today.
“Evidence is growing, but a direct link has not been made yet,” according to Amee Manges, PhD, of the University of British Columbia School of Population and Public Health in Vancouver. Still, she said, “these results add to the existing body of research.”
In 2016 and 2017, Yamaji and colleagues analyzed 1,020 urine samples from UTI patients at a university-affiliated healthcare center and 200 meat samples from Northern California retail stores. The meat — chicken breast, ground turkey, ground beef, and pork chops — was collected as part of an FDA program called the National Antimicrobial Resistance Monitoring System.
The research isolated E coli from 210 (21%) of the urine samples. E coli is “by far the most common species infecting” the urinary tract, wrote the authors of a 2009 study of the strains that cause human UTIs.
E coli was also found in 76 (38%) of the meat samples. Ground turkey had the highest rate of contamination at 73%, followed by 43% of chicken breasts, 18% of ground beef, and 15% of pork chops.
The level of E coli contamination in the meat is not unusual, co-author Cindy Friedman, MD, of the CDC told MedPage Today, but proper cooking generally destroys the germs.
However, she said, it’s possible that E coli in meat could survive cooking and enter the digestive tract. It could enter the urinary tract via fecal matter contamination, especially in women, who are vulnerable to UTIs due to anatomy, she said.
Eleven (32%) of 34 chicken samples contained uropathological strains of E coli. These strains also appeared in 4 (14%) of ground turkey samples and one (17%) of the pork chop samples. No beef samples contained the strains.
In terms of drug resistance, “E coli isolates from retail meat were mostly pan-susceptible, while several pandemic lineages from human isolates were highly resistant,” Yamaji said.
That raises a question, she said: “Is there a difference in antimicrobial susceptibility between E coli isolates from retail meat and in human UTI within the same genotypes?” Perhaps, she said, human genes linked to drug resistance act upon the E coli strains in the human intestine.
The next step in research, she said, is to launch genome sequencing to better understand the connections between E coli in meat and in human urine. She also hopes to discover the sources of the three pandemic E coli lineages in humans that were not found in the retail meat.

The authors did not report external support for the the study. They made no relevant disclosures.
Manges made no relevant disclosures.
• Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
• Primary Source
IDWeek 2017
Source Reference: Yamaji R, et al “Retail meat as a potential transmission source of community-acquired urinary tract infection” IDWeek 2017; abstract 955.